LB71
Non-statutory palliative care in the community: a systematic review of clinical and cost effectiveness
Bridget Candy, Amanda Holman, Sarah Davis, Baptiste Leurent, Louise Jones
Royal Free and University College Medical School, London, UK
Background
Across Europe community palliative care services including hospice and
end-of-life home care are provided by non-statutory organisations, such as
Marie Curie Cancer Care in the UK. The provision of such services has grown and
may increase as people live longer with advanced progressive life threatening
conditions. In the early 2000s several reviews called for higher quality
research into the merits of palliative care services. Recently, UK Department
of Health reports, including the End of Life Care Strategy (2008), recognised
the importance of providing an evidence base through which services can be
commissioned.
Aim
To establish the evidence base for the clinical and cost effectiveness of
non-statutory palliative care.
Method
With reference to the UK, non-statutory palliative care was considered to
be palliative home care, hospice inpatient and day-care, or hospice nursing
home care. Quantitative evaluations comparing non-statutory palliative care
services with usual care, as well as thematic analyses exploring the community
palliative care experiences of patients, and carers were included. Four
citation databases were searched to 2009. Evidence was assessed for quality in
accordance with Cochrane and CASP guidelines.
Results
16 comparative evaluations and 12 thematic studies were identified. Most
studies evaluated supportive home care and were conducted in the UK or US. Three randomised controlled trials were identified. Seven studies incorporated a
costing element. None were full economic evaluations. Evidence suggests
services reduce general health service use, inpatient mortality, and increase
carer and patient satisfaction with care. Recurring themes in thematic analyses
were positive overall. Palliative home services were seen to support carers to
sustain patient care, and day-care provided the patient renewed meaning.
Evidence was limited by retrospective and nonrandomised study designs, and
narrow costing perspectives.
Conclusion
Evidence suggests that these services reduce general health service use and
associated costs, and increase satisfaction with healthcare. However,
future research is needed using more robust study designs.
